Impact of the Use of a Standardized Guidance Tool on the Development of a Teaching Philosophy in a Pharmacy Residency Teaching and Learning Curriculum Program.

The purpose of this study was to evaluate the impact of a standardized reflection tool on the development of a teaching philosophy statement in a pharmacy residency teaching and learning curriculum program (RTLCP). Pharmacy residents participating in the RTLCP over a two-year period were surveyed using a pre/post method to assess perceptions of teaching philosophy development before and after using the tool. Responses were assessed using a 5-point Likert scale to indicate level of agreement with each statement. For analysis, responses were divided into high (strongly agree/agree) and low (neutral/disagree/strongly disagree) agreement. The level of agreement increased significantly for all items surveyed (p < 0.05), with the exception of one area pertaining to the ability to describe characteristics of outstanding teachers, which was noted to be strong before and after using the tool (p = 0.5027). Overall results were positive, with 81% of participants responding that the reflection tool was helpful in developing a teaching philosophy, and 96% responding that the resulting teaching philosophy statement fully reflected their views on teaching and learning. The standardized reflection tool developed at Shenandoah University assisted pharmacy residents enrolled in a teaching and learning curriculum program to draft a comprehensive teaching philosophy statement, and was well received by participants.

Prospective trial of a novel nomogram to achieve updated vancomycin trough concentrations.

Purpose. To determine if the use of a novel vancomycin nomogram predicts dosing regimens that achieve target trough concentrations equal to or more accurate than dosing regimens calculated using traditional pharmacokinetic calculations, evaluate the incidence of subtherapeutic and supratherapeutic troughs, and assess pharmacist's impressions of the nomogram. Methods. Prospective, open-label study in 473 patients who had a new order for vancomycin and were >18 years of age and ≤120 kg. Patients were randomized to the active group, dosed using the nomogram, or to the control group, dosed using traditional pharmacokinetic calculations already in place at our institution. Results. Patients dosed via nomogram were within the appropriate trough range in 44% of cases compared to 33% in the control group (P = 0.014). Vancomycin troughs less than 10 mcg/mL were significantly decreased with the use of nomogram (P = 0.032). Incidence of supratherapeutic troughs, greater than 20 mcg/mL, was not significantly different between groups (P = 0.706), and pharmacists agreed that the nomogram was easy to use and saved their time. Conclusions. A novel vancomycin nomogram was prospectively validated and found to be more effective than traditional pharmacokinetic dosing. The nomogram is being implemented as the standard dosing protocol at our institution.

Effect of preoperative N-acetylcysteine on postoperative blood loss parameters in cardiac surgery patients.

Purpose. To determine if recent preoperative exposure to n-acetylcysteine (NAC), Mucomyst, increases postoperative blood loss in cardiac surgery patients. Methods. Retrospective review of cardiac surgery patients who underwent a cardiac catheterization within four days of surgery and whose serum creatinine was ≥1.0 mg/dL. The study groups were those who received NAC in the pericatheterization period versus those who did not. The primary endpoint was postoperative chest tube output at 24, 48, and 72 hours. Secondary endpoints included number of transfusions and other bleeding parameters. Results. Mean blood loss in the first 24 hours was 962 ± 595 mL in the treatment group (n = 79) and 1,178 ± 788 mL in the control group (n = 106), P = .040. Blood loss between groups at 48 (366 ± 318 mL versus 412 ± 363 mL, P = .382) and 72 (194 ± 300 mL versus 176 ± 224 mL, P = .643) hours was not significantly different. There were no significant differences in postoperative transfusions or other bleeding parameters. Conclusions. Preoperative exposure to NAC did not increase postoperative blood loss or negatively affect other bleeding parameters.